Preadmission Screening and Resident Review (PASRR) identifies possible serious mental illness or intellectual disability among applicants to Medicaid-certified nursing facilities and determines the services needed by people referred for further evaluation. Resident review addresses significant changes in covered residents’ physical or mental condition. Integral Healthcare Solutions (IHS) drafts the facility’s admission workflow, referral log, transfer checklist and staff training.
Last reviewed November 5, 2026. Sources linked here were opened November 5, 2026: current eCFR Title 42 (last amended October 8, 2026), Social Security Act §1919 and CMS PASRR materials. Subpart C retains annual-review wording that CMS identifies as superseded by the 1996 statutory change.
What is PASARR?
It is a State-run screening and review program defined in 42 CFR 483.100 to 483.138. Section 483.102(a) applies the subpart to the screening or reviewing of all individuals with mental illness or intellectual disability who apply to or reside in Medicaid certified nursing facilities, regardless of the source of payment for the nursing facility services and regardless of the individual's or resident's known diagnoses. Level I identifies who is suspected of having mental illness or intellectual disability; Level II evaluates and determines whether nursing facility services and specialized services are needed (483.128(a)).
Who must be screened, and when?
CMS describes Level I screening for all applicants to Medicaid-certified nursing facilities; suspected serious mental illness or intellectual disability leads to Level II evaluation. 42 CFR 483.106 distinguishes new admissions, exempted hospital discharges, readmissions and transfers. Although Subpart C retains annual-review wording, Congress removed the annual requirement in 1996. Resident review is required promptly after significant-change notification under Social Security Act §1919(e)(7)(B)(iii); CMS explains the outdated wording in its PASRR fact sheet.
Are there exceptions?
Under 42 CFR 483.20(k)(2)(ii), a State may exempt a hospital discharge when all three conditions hold: direct admission after acute inpatient hospital care, nursing facility services needed for the condition treated there, and the attending physician’s certification before admission that fewer than 30 days of nursing facility services are likely. If the person is later found to need more than 30 days, the State mental health or intellectual disability authority must conduct resident review within 40 calendar days of admission (42 CFR 483.106(b)(2)).
Readmissions and interfacility transfers are subject to resident review rather than a new preadmission screen (42 CFR 483.106(b)(3)–(4)). A transfer between nursing facilities includes a move with or without an intervening hospital stay. Neither creates an annual cycle.
Who decides?
The appropriate State authority determines whether the applicant’s physical and mental condition requires nursing facility services and, if so, whether specialized services are needed (42 CFR 483.112(a)–(b)). For mental illness, the decision must rest on an independent physical and mental evaluation by someone other than the State mental health authority (42 CFR 483.106(d)). Written notice goes to the individual and legal representative, admitting or retaining facility, attending physician, and discharging hospital; the hospital-notice requirement excludes exempted hospital discharges (42 CFR 483.130(k)).
What must travel with a transferred resident?
When a resident with mental illness or intellectual disability is transferred from a nursing facility to a hospital or to another nursing facility, the transferring facility is responsible for ensuring that copies of the resident's most recent PASARR and resident assessment reports accompany the resident (483.106(b)(4)(ii)).
Who needs it and what triggers it
Medicaid-certified nursing facilities need a process for screening applicants, handling exceptions and referring covered residents for review. Facility obligations also appear in the long-term care participation requirements:
- Before admission: for a new resident covered by 42 CFR 483.20(k), the appropriate State authority must determine that nursing facility services are needed and, if so, whether specialized services are needed. For serious mental disorder, an independent physical and mental evaluation by someone other than the State mental health authority must support the decision. Readmissions and State-elected qualifying hospital-discharge exemptions are addressed in (k)(2); intellectual disability includes the related conditions referenced in (k)(3).
- After a significant change: a nursing facility must notify the State mental health or intellectual disability authority promptly after a significant change in the mental or physical condition of a resident who has a mental disorder or intellectual disability, for resident review (483.20(k)(4)).
- In assessment: coordinate with PASRR to the maximum extent practicable to avoid duplicate testing and effort. Incorporate Level II recommendations into assessment, care planning and transitions, and refer all Level II residents and residents with newly evident or possible serious mental disorder, intellectual disability or a related condition for Level II review upon a significant-change-in-status assessment (42 CFR 483.20(e)).
This page covers federal requirements. IHS uses the client’s current State instructions to draft the local procedure; State procedures do not replace federal requirements.
How IHS helps
IHS is a consulting firm with three practice lines: accreditation consulting, compliance services and program development. PASARR readiness is compliance services with program-development content for the workflow. Thomas G. Goddard, JD, PhD, who founded IHS in 2002 and served as URAC's Chief Operating Officer and General Counsel, leads it.
- A gap assessment and document/evidence map against the applicable federal requirements and your State’s procedures.
- An admission-screening workflow that places the screen before admission and handles readmissions, transfers and exempted discharges separately.
- A referral log of each referral, its date, the State's written determination and the date it arrived.
- A transfer packet checklist built on 483.106(b)(4)(ii).
- A significant-change referral step tied to the State notification duty.
- Staff training, and a mock review of a sample of admission files.
IHS drafts program documents and workflow content for client approval, with clinical content approved by the client’s clinicians. Mock review and readiness support test staff use.
What you supply: your State's PASARR forms and portal access, a sample of recent admission and transfer files, your admissions staff and social workers, and your medical director.
The real limit: the State authority makes determinations, not the facility or IHS. IHS does not file anything with a State authority or communicate with one on your behalf; your facility does.
What to have ready
Federal sources below were opened November 5, 2026. Logs and training records are IHS tools, not federally prescribed forms.
- A Level I identification step for applicants, with exceptions handled separately (42 CFR 483.128(a); 42 CFR 483.106(b)).
- Evidence of required preadmission determinations, including later written confirmation if the State initially conveys its decision verbally (42 CFR 483.112(c)(2); 42 CFR 483.20(k)).
- A significant-change notification and referral process, not a federal annual PASRR calendar (Social Security Act §1919(e)(7)(B)(iii); 42 CFR 483.20(e), (k)(4)).
- A readmission/transfer classification check and copies of the most recent PASARR and resident assessment reports for covered residents (42 CFR 483.106(b)(3)–(4)).
- A qualifying hospital-discharge check covering the State election, all three conditions, and review within 40 calendar days if more than 30 days of care become necessary (42 CFR 483.20(k)(2); 42 CFR 483.106(b)(2)).
- A method to incorporate Level II recommendations into assessment, care planning and transitions (42 CFR 483.20(e)(1)).
- Current State instructions and a referral log mapped to State determinations and written notices (42 CFR 483.130(j)–(k)).
- A staff training record addressing identification, transfers and significant-change referrals (42 CFR 483.128(a); 42 CFR 483.106(b)(4); 42 CFR 483.20(e)).
To see where your workflow stands, start with the introductory call.
How it compares
Preadmission screening, resident review and transfer documentation have different triggers. These are complementary program steps.
| Event | Trigger | Facility’s part |
|---|---|---|
| Preadmission screening | New admission, subject to applicable exceptions | Complete identification and obtain required determinations before admission |
| Resident review | Significant-change notification; applicable time-limited-stay review | Notify and refer; track the applicable review deadline |
| Transfer documentation | Covered resident moves to a hospital or another nursing facility | Send the most recent PASARR and resident assessment reports |
See 42 CFR 483.106(b), 42 CFR 483.20(k) and Social Security Act §1919(e)(7)(B)(iii). State authorities remain responsible for PASRR determinations.
A facility may apply a State-developed category after Level I only when existing information appears current and accurate and is sufficient to establish readily that the person fits the category. A categorical nursing-facility determination does not waive the specialized-services determination (42 CFR 483.130(c), (i)).
What it costs
Three costs apply. First, the government: the federal text reviewed on this page states no fee for PASARR screening. Second, consulting: IHS scopes each engagement after a free introductory call. What moves the scope is the number of facilities, how many States you operate in, and the gaps between your current process and the workflow. Third, your own staff time to learn and run the workflow.
What this is not
- It is not legal advice. IHS is a consulting firm, not a law firm.
- It is not a determination of whether a person needs nursing facility care. The State authority decides.
- It is not a guarantee of a survey result. The survey agency decides.
Frequently asked questions
Who must be screened before a nursing facility admits someone?
CMS describes preliminary Level I screening of all applicants to Medicaid-certified nursing facilities, regardless of payer, to identify possible serious mental illness or intellectual disability (CMS PASRR overview; 42 CFR 483.102(a)). People identified for further evaluation proceed to Level II. New admissions, readmissions, transfers and qualifying hospital-discharge exemptions are distinguished in 42 CFR 483.106(b).
Who decides whether nursing facility care is appropriate?
The State mental health authority or the State intellectual disability or developmental disability authority, as appropriate (42 CFR 483.112(a)). The facility does not make that determination, and neither does IHS.
Can a facility admit someone while the State determination is pending?
For a covered new resident, the required nursing-facility and, where applicable, specialized-services determinations must precede admission (42 CFR 483.20(k)(1)). The mental-disorder determination must rest on an independent physical and mental evaluation by someone other than the State mental health authority. Paragraph (k)(2) addresses readmissions and State-elected qualifying hospital-discharge exemptions; 42 CFR 483.106(b)(4) addresses interfacility transfers.
What is the exempted hospital discharge?
A State may exempt direct admission after acute inpatient hospital care when nursing facility services are needed for the hospital-treated condition and the attending physician certifies before admission that fewer than 30 days of nursing facility services are likely (42 CFR 483.20(k)(2)(ii)). All three conditions apply. If the person is later found to need more than 30 days, the State authority must conduct resident review within 40 calendar days of admission (42 CFR 483.106(b)(2)).
Do readmissions and transfers need a new preadmission screen?
No new preadmission screen is required for these categories under 42 CFR 483.106(b)(3)–(4). A readmission returns someone from the hospital to which the facility transferred them for care; an interfacility transfer moves someone between nursing facilities, with or without a hospital stay. Resident-review duties still apply, including review after significant-change notification.
What must travel with a resident who transfers?
The most recent PASARR and resident assessment reports must accompany a resident with mental illness or intellectual disability transferred from a nursing facility to a hospital or another nursing facility (42 CFR 483.106(b)(4)(ii)). The transferring facility is responsible for ensuring the copies accompany the resident.
What does the facility own, and what does the State own?
The State PASARR program identifies individuals suspected of having mental illness or intellectual disability (Level I) and evaluates and determines the need for nursing facility services and specialized services (Level II) (42 CFR 483.128(a)). The facility owns its admission workflow, referral and significant-change practice and records (483.20(e) and (k)). IHS drafts that workflow for your leaders to approve.
Does this page replace my State's PASARR manual?
No. This page summarizes federal requirements; the facility also needs its current State PASRR instructions. IHS drafts the facility workflow using those instructions and the applicable federal requirements.